Ensuring quality in pharmacy operations has multiple implications including patient safety, better patient outcomes, better patient relationships, and better financial performance of the pharmacy organization. There are many foundational concepts such as continuous quality improvement (CQI) and total quality management (TQM). One of the more widely known set of techniques to promote quality is that of Six Sigma, which seeks to identify and remove causes of defects (or errors) and minimize variability in production (eg, pharmacy operations). Six Sigma principles have been applied with considerable success in pharmacy operations. A variation of Six Sigma is Lean Six Sigma. Lean Six Sigma is a methodology that relies on a collaborative team effort to improve performance by systematically reducing waste while also reducing variation in production. In doing so, it centers on the mitigation of DOWNTIME (Defects, Overproduction, Waiting, Non-utilized talent, Transportation, Inventory, Motion, Extra-processing).
Lamm et al examined the use of Lean Six Sigma principles to improve adult infusion chemotherapy preparation times in a 3-phase study.1 In phase 1, chemotherapy turnaround times in the clinic were examined one year after the interim goal of a 45-minute turnaround time was established. Phase 2 implemented various experiments including a five-day Kaizen (consensus-gathering) event using lean principles in an effort to decrease chemotherapy preparation turnaround times. Phase 3 included the implementation of process-improvement strategies identified during the Kaizen event. In phase 1, the mean turnaround time for all chemotherapy preparations decreased from 60 to 44 minutes. After installing new processes, the mean turnaround time improved to 37 minutes for each preparation in phase 2. In phase 3, the mean turnaround time decreased from 37 to 26 minutes. The overall mean turnaround time was reduced by 26 minutes, representing a 57% decrease in 19 months. This reduction was accomplished through increased efficiencies in the workplace, with no addition of human resources.
Pharmacy managers can improve quality, improve patient safety, and the pharmacy’s financial performance with the application of well-known principles adapted from industries outside of health care. Processes like Lean Six Sigma are a common part of the contemporary management lexicon, and pharmacists should familiarize themselves with these.
Additional information about Ensuring Quality in Pharmacy Operations can be found in Pharmacy Management: Essentials for All Practice Settings, 4e. If you or your institution subscribes to AccessPharmacy, use or create your MyAccess Profile to sign-in to Pharmacy Management: Essentials for All Practice Settings, 4e. If your institution does not provide access, ask your medical librarian about subscribing.
1Lamm LH, Eckel S, Daniels R, Amerine LB. Using lean principles to improve outpatient adult infusion clinic chemotherapy preparation turnaround times. Am J Health Syst Pharm. 2015;72:1138-1146.
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what sort of quality paradigms are the basis for operations in your pharmacy org?
Very well written piece that provides a good example that readers can understand how Lean Six Sigma can be applied in the healthcare setting, and specifically in pharmacy. I especially liked that you included the part that the changes implemented did not include a loss of personnel in this example, despite that being a possibility in some situations.
Indeed, when managed well, improvements in efficiency need not result in loss of human FTEs; rather, it can result in a shifting of job responsibilities of those FTEs into more meaningful work in direct patient care activities.